In the Journals

Opioid prescription rate 20% after cardiac device implantation

One-fifth of patients were prescribed opioids after cardiac implantable electronic device procedures, most of whom were opioid naive, according to a study published in HeartRhythm.

“These findings suggest that we need to pay more attention to ways to improve pain management after device procedures,” Justin Z. Lee, MBBS, fellow in the department of cardiology at Mayo Clinic, told Cardiology Today.

Researchers analyzed data from 16,517 patients (mean age, 70 years; 36% women) who underwent a cardiac implantable electronic device procedure and were discharged between 2010 and March 2018. The procedures patients underwent were categorized as the following: new cardiac implantable electronic device implantation, device upgrade, generator change, subcutaneous implantable cardiac defibrillator, lead revision/replacement and other cardiac implantable electronic device procedures.

Health care providers prescribed opioids based on their discretion.

“There are a lot of variations in prescription practices, and these variations are influenced by many different factors, ranging from provider factors, patients’ expectations of pain control, underlying comorbidities and personal sensitivity to pain,” Lee said in an interview.

Data on opioid prescriptions within 90 days before the procedure and up to 30 days after discharge were assessed, in addition to characteristics such as dosage, type, quantity, frequency and oral morphine equivalents. Patients were considered to be opioid naive if they did not receive any opioid prescription 90 days before the procedure. Prescription refills were defined as any opioid prescribed between 1 and 30 days after discharge.

The primary outcome was defined as an opioid prescription after discharge for the device procedure.

Patients who were discharged with an opioid prescription accounted for 20.2% of the study population, of whom 79.7% were opioid naive. New opioid refills were completed in 9.4% of patients who were opioid naive (95% CI, 8.3-10.5). There were 38.8% of patients who received a high-dose opioid prescription, defined as more than 200 oral morphine equivalents (95% CI, 37.2-40.5).

The rate of opioid prescriptions increased from 2010 to 2015, which peaked at 25.9% in 2015 and decreased to 14.6% in 2018 (P < .001).

“We need more studies to evaluate the various methods to decrease opioid prescription rates such as emphasizing alternative pain management strategies such as emphasizing the use of nonopioid medications,” Lee told Cardiology Today. – by Darlene Dobkowski

For more information:

Justin Z. Lee, MBBS, can be reached at lee.justin1@mayo.edu.

Disclosure s : The authors report no relevant financial disclosures.

One-fifth of patients were prescribed opioids after cardiac implantable electronic device procedures, most of whom were opioid naive, according to a study published in HeartRhythm.

“These findings suggest that we need to pay more attention to ways to improve pain management after device procedures,” Justin Z. Lee, MBBS, fellow in the department of cardiology at Mayo Clinic, told Cardiology Today.

Researchers analyzed data from 16,517 patients (mean age, 70 years; 36% women) who underwent a cardiac implantable electronic device procedure and were discharged between 2010 and March 2018. The procedures patients underwent were categorized as the following: new cardiac implantable electronic device implantation, device upgrade, generator change, subcutaneous implantable cardiac defibrillator, lead revision/replacement and other cardiac implantable electronic device procedures.

Health care providers prescribed opioids based on their discretion.

“There are a lot of variations in prescription practices, and these variations are influenced by many different factors, ranging from provider factors, patients’ expectations of pain control, underlying comorbidities and personal sensitivity to pain,” Lee said in an interview.

Data on opioid prescriptions within 90 days before the procedure and up to 30 days after discharge were assessed, in addition to characteristics such as dosage, type, quantity, frequency and oral morphine equivalents. Patients were considered to be opioid naive if they did not receive any opioid prescription 90 days before the procedure. Prescription refills were defined as any opioid prescribed between 1 and 30 days after discharge.

The primary outcome was defined as an opioid prescription after discharge for the device procedure.

Patients who were discharged with an opioid prescription accounted for 20.2% of the study population, of whom 79.7% were opioid naive. New opioid refills were completed in 9.4% of patients who were opioid naive (95% CI, 8.3-10.5). There were 38.8% of patients who received a high-dose opioid prescription, defined as more than 200 oral morphine equivalents (95% CI, 37.2-40.5).

The rate of opioid prescriptions increased from 2010 to 2015, which peaked at 25.9% in 2015 and decreased to 14.6% in 2018 (P < .001).

“We need more studies to evaluate the various methods to decrease opioid prescription rates such as emphasizing alternative pain management strategies such as emphasizing the use of nonopioid medications,” Lee told Cardiology Today. – by Darlene Dobkowski

For more information:

Justin Z. Lee, MBBS, can be reached at lee.justin1@mayo.edu.

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Disclosure s : The authors report no relevant financial disclosures.